Nursing Culture & Why It’s Hard To Stay In Shape

My name is Lauren Drain and I want to talk to you about the difficulties we as nurses face when it comes to being healthy and staying in shape. We as nurses have an incredibly good track record for going the extra mile to care for our patients and the patients’ families. We spend 8-12 hours a day on our feet doing bedside care, making phone calls, administering meds, printing and going over educational/care instructions for their patients during every shift – and that’s just scratching the surface. The nursing culture is extremely patient-focused. Often, the well-being and self-care of the nurse get completely lost in the shuffle, with added guilt if they do put their self-care first. Ignoring their own well-being becomes a habit that leads to a lot of self-neglect and creates a domino effect of poor choices.

As a nurse of 10 years, I have come to discover many factors that have led to nurses’ lack of self-care both on the job and on their days off. Most nurses work 36-40 hours a week (four 8 hour shifts or three 12 hour shifts). For their days on, these long shifts leave little to no time before or after to dedicate to stress-relieving activities (such as exercise, yoga, Pilates, meditation, or walks). Most nurses feel exhausted after being on their feet all day due to lack of sleep (five hours or less a night). I have heard many co-workers complain about having to skip their lunch or meal breaks on a regular basis; as if skipping meals is the “norm” in nursing culture. Most laws only require one 30 minute, uninterrupted, unpaid lunch break per shift (normal shifts times are 8 or 12 hours). Some hospitals or nursing units encourage additional short breaks (5-15 minute paid breaks) for the restroom, coffee, smoking, rest, etc.; however, most laws and units do not enforce the breaks. Nurses do not expect to take more than one meal break per day and, therefore, barely pack enough food or snacks to sustain a fast metabolism.

Additionally, nurses have at least one patient, if not more, that require frequent bedside checks. Leaving them unattended for an extended period is not acceptable. Nurses are solely responsible for vital signs, bedside checks, fielding phone calls from family/doctors/friends/caregivers/other staff, thereby interrupting their breaks. In addition to these duties, nursing staff deal with weekly short staffing, high acuity patients, unexpected admissions/discharges, and other emergencies. This fast-paced culture actively discourages nurses from taking their required 30-minute meal break, a restroom break, or any rest period during their long, busy, stressful shifts, which leads to poor self-habits.

Some of these habits include: avoiding drinking water, not using the restroom (which can lead to dehydration and headaches), and often drinking more coffee/tea to stay awake, which also contributes to dehydration. Most of my co-workers needed coffee to survive their shifts and ONLY drank coffee, with zero hydration. This habit becomes unhealthy for obvious reasons: no water = no hydration = no elimination of toxins = overworked adrenal glands by constant stimulants. Dehydration leads to overeating, poor kidney cleansing, the buildup of toxins, headaches, sugar cravings, and poor blood pressure. Now, consider that these patterns are done often, over extended periods of time, up to 10 or 20 years. Consider the lasting effects on the body.

On top of those bad habits, add to the mix that nurses are extremely stressed due to the high demands of their job 8 – 12 hours a day. Stress causes increased release of cortisol, which leads to all types of problems, like sweet cravings, high blood sugar, increased fat storage, muscle breakdown, reduced quality of sleep… the list goes on. Stress also leads to poor eating habits, like grabbing high glycemic foods which lead to sugar spikes, sugar drops, and that “afternoon crash” when your energy plummets and you like napping (a frequent complaint I have heard nursing staff mention). Also, sugar crashes lead to mood swings and poor work ethic. It’s ironic that ignoring these genuine issues is resulting in a worse work environment. Without any required or encouraged breaks, nurses can keep this stress response going all shift, shift after shift. Even 10-15 minutes every 4 hours could reduce this stress response; a chance to take deep breaths, relax and focus on something healthy, or have the opportunity to drink water and/or have a healthy snack (low glycemic, coupled with protein), all of which can significantly reduce the stress response.

In addition to feeling stressed during shifts, I have noticed a trend from many of my nursing staff co-workers to take their days off as a way to decompress which leads to kind of a bipolar lifestyle of self-stress followed by self-neglect. An “all work/high stress” schedule followed by “total relaxation” lifestyle can confuse the body and the metabolism, especially coupled with zero exercise or proper nutrition. The body feels starved during days on, and overfed during days off. Since nurses are often so stressed and exhausted from their shifts at work, they use days off to relax, catch up on errands, spend time with family and participate in leisure time. Not to say the leisure time is not good or effective, but it leads to a negative trend with zero time for exercise and the self-care that is necessary to maintain healthy habits. There must be a method that includes exercise. It helps energize the body for both on and off days and reduces the stress response the body goes through during the on shift.

Another issue I noticed which was quite prevalent in all units and hours of the day, and almost impossible to avoid as a nurse, was the constant accessibility of unhealthy foods around the staff lounge. Patients and families bring treats daily as a kind gesture to the nursing staff, but it serves as daily temptation and continues the vicious cycle of poor nutrition already amplified by the lack of meal breaks in 12 hours. In addition to patient treats, staff parties fuel the temptation, which creates an addiction to sugar given the elevated cortisol running through all staff members’ bodies.

The irony is, in a 12-hour period, one of the healthiest ways to fuel your body is to consume anywhere from 3-5 meals, every 3-4 hours. We teach our patients who have diabetes (and other nutrient deficiencies or GI disorders) this concept, yet we are unable to implement it given the current nursing culture. Skipping breakfast and/or meals leads to muscle wasting, decreased mental sharpness, reduced energy, and blood sugar drops that lead to sugar cravings. Nurses would be better equipped mentally and physically if they were energized, less stressed, and appropriately nourished throughout their shift due to the demand for critical thinking and physicality of the job.

Sadly, we have been conditioned to replace water, nutrients, vitamins, and meals with coffee and tea. We avoid exercise because we are so exhausted, even though four 30-minute workouts a week drastically reduces stress, improves mood, improves sleep, and re-energizes the body for work. Nursing staff is required to transport debilitated patients and heavy equipment multiple times a shift several shifts a week. Without regular exercise, the core cannot sustain proper body mechanics and protect the lower back against low back/neck problems. Core body workouts from yoga, floor workouts, weightlifting and other forms of exercise for merely 30 minutes, 4-5 times a week can effectively build a core that protects against the very injuries nursing staff is most susceptible.

Since I have noticed that it is not impressed upon nursing staff to keep or start healthy habits, I have developed a few habits that I used as a nurse and have shared with other nursing staff to successfully lose weight, increase energy, decrease stress and increase overall well-being. I have rarely been on a nursing unit or talked to a nurse that has a successful, motivating culture that is healthy for the nurse. Almost all staff meetings seem to revolve around better patient satisfaction, which adds to the never-ending list of nurse-related duties and expectations. But this can change.

Here are some of the healthy suggestions: Find a way to incorporate exercise into your schedule. Most nurses have 3-4 days off, which makes it a little easier to include exercise on those days. Start with a 30-minute workout 3-4 days a week and work up to an hour over the course of several weeks. Focus on core exercises to reduce back pain (pilates, yoga, at home ab workouts). Focus on weight lifting to become stronger, more energetic, and improve body mechanics for heavy lifting at work – even physical appearance. Focus on cardio to reduce body fat and increase endurance/energy. All forms of fitness will enhance stress levels, sleep, and mood. Even though the idea of exercise when exhausted or stressed seems overwhelming, it reduces stress as well as cortisol, back pain, and random body aches. Exercise increases restful REM sleep, circulation, and resets hormones; it improves serotonin levels in the body, leading to improved mood and decreased stress responses.

As far as nutrition goes, here are my healthy tips: Drink more water (this will reduce cravings, hydrate the body, and reduce headaches). This may lead to a couple more potty breaks, but don’t feel guilty. After about a week of consistently increased hydration, the body adapts, and you won’t require as many restroom breaks. Prepare at least three meals (or one meal and two properly balanced snacks) for your nursing shift. You can either cut your 30-minute lunch break into three 10 minute breaks or if your hospital policy allows for an additional one or two 15 minute breaks, use those to eat your well-balanced meals/snacks. Discuss with staff and co-workers the possibility of starting weight loss or diet challenges on your unit and set up weekly goals or check-ins. Make a “grand prize” awarded to the top one or two winners (each person contributes a small amount to the prize pool).

If you want to see a practical challenge many nurses have joined, I run 6-week weight loss challenges and give out $5000 in cash prizes to the top ten winners.

I am a certified personal trainer and a registered nurse with 10 years of experience, so I know how to build an effective plan tailored to our culture. This type of challenge creates teamwork, unity, respect, and helps encourage participants to work towards a common goal – and is much more likely to allow short 10-minute meal breaks throughout the 12-hour shift, instead of all nurses taking their lunch break together leaving the floor empty for 30+ minutes during lunch.

Doing a challenge together will encourage your staff to prepare meals or bring in healthy snacks/meals/shareables like veggie plates, fruit plates, and nuts to help promote a healthy work environment. Co-workers can post up healthy recipes and help others stay on track. Healthy snacks help with the temptation to graze on the unhealthy options that are available 24/7. Your nursing unit can even start a Facebook Support Group to share fitness workouts, tips, recipes, flex photos, progress pictures, weigh-ins, measurement updates, diet memes, fitness memes and vent about daily or weekly struggles. I have very encouraging Facebook Support Groups with every challenge I run, and it directly contributes to much higher success rates.